The Doctor is Out…Driving While Medically Unqualified

NOTE: This article is part of a series investigating the definition of “impaired driving” as it occurs in society, traffic safety and driver safety professional networks.

The Federal Motor Carrier Safety Administration (FMCSA), has enforced regulations to prevent drivers from operating Commercial Motor Vehicles while impaired in a number of ways.  One area that the organization has been working very hard to enhance is keeping medically unqualified drivers from behind the wheel.
Traditionally, this has been done (mainly) by requiring a biennial (once every two years) or more frequent (if a notable health/medical condition exists) visit to a certified medical doctor for a physical exam.  To provide an additional set of elements to the “safety net” there are substance abuse testing protocols completed by the employer, and roadside inspections to spot driver irregularities during the course of the year.
In theory, this system of checks and balances should capture the majority of exceptions and assure a consistent pool of qualified drivers.  However, a recent report published in November 2012 by the Government Accountability Office (GAO) “…found that these controls were vulnerable to abuse or manipulation.”  This report describes key controls designed to prevent medically unfit or impaired commercial drivers from operating commercial vehicles, and examples of commercial drivers with potentially disqualifying impairments related to epilepsy, drugs, or alcohol who managed to drive despite the existence of the key controls.
It also points out how some of the worst issues will be addressed by MAP-21 (link to summary here)
The study that led to the report was conducted in the following manner:
“To identify key controls, GAO reviewed FMCSA policies and regulations, and interviewed officials. Cases were identified on the basis of FMCSA roadside-inspection data, DOT’s Commercial Driver License Information System (CDLIS), a national database of all commercial drivers, and SSA disability insurance files. From this analysis, GAO identified commercial drivers who were driving with an epilepsy diagnosis. GAO also randomly selected 100 individuals to determine whether the driver was receiving SSA disability benefits when the state issued or renewed the driver’s CDL.” [underline added for emphasis]
Notable findings from GAO report summary:
“Matching CDL holders with Social Security Administration (SSA) disability files produced 204 commercial drivers who drove a commercial vehicle as recently as 2011 despite having epilepsy, a disqualifying medical condition characterized by sudden seizures and unconsciousness. Thirty-one of these drivers were involved in accidents, demonstrating the threat to public safety posed by medically impaired drivers. GAO also identified 23 cases where state licensing agencies issued or renewed CDLs for drivers after they were, according to SSA records, diagnosed with epilepsy or had drug or alcohol dependence noted, which could also disqualify them from driving under DOT regulations.  However, because DOT did not require state licensing agencies to maintain drivers’ medical certifications at the time of GAO’s review, it is unlikely that states knew of the drivers’ conditions. In fact, they were unable to provide medical certifications for any of the 23 individuals. States are now required to electronically store medical certificates for new and renewing CDL applicants and will be required to electronically maintain this information for all CDL holders by January 2014. Doing so could help prevent ineligible drivers from obtaining or renewing CDLs in the future.”

Here is a link to the full GAO Report – http://www.gao.gov/assets/660/650388.pdf

Bottom-line is that drivers with “serious medical conditions” can still meet FMCSA fitness requirements because “…medical determinations rely on subjective factors and patient self-reporting, [therefore] it is not possible to systematically determine whether these drivers had disqualifying medical conditions.”

This will require changes to how medical qualifications are completed and recorded.  The GAO report summarizes several key changes that are on the way or will be here very soon:

  • “As of January 30, 2012, individuals renewing or applying for a CDL must submit a copy of their current medical certificate to their state licensing agency, making state licensing agencies responsible for ensuring that drivers have current medical certificates on file.
  • “In April 2012, FMCSA published a final rule establishing a National Registry of Certified Medical Examiners.
  • “The 2012 final rule provides requirements for all healthcare professionals responsible for issuing medical certificates for interstate truck and bus drivers to complete a training course on the Federal physical qualifications rules and to pass an examination to assess the examiners ability to apply the rules, and advisory criteria in a consistent manner when making the determination whether a driver meets the qualification standards.
  • “FMCSA has announced its plans to initiate a new rulemaking that would enable the agency to require medical examiners on the National Registry to submit to the agency the medical certificate information on each individual who applies for a medical certificate. The agency would then have the ability to transmit to the state driver licensing agency the medical certificate. This process will significantly decrease the likelihood of drivers being able to falsify medical certificates.
  • “Specifically, the law [MAP-21] requires DOT to establish, operate, and maintain a national clearinghouse with records relating to the results of positive drug and alcohol tests of commercial drivers or instances of refused tests. Once the clearinghouse has been established, employers must request and review their CDL drivers’ records from the clearinghouse annually. The MAP-21 Act also requires DOT to develop a method to electronically notify an employer of each additional positive test result or other noncompliance.
  • “Specifically, the law requires DOT to establish, operate, and maintain a national clearinghouse with records relating to the results of positive drug and alcohol tests of commercial drivers or instances of refused tests. Once the clearinghouse has been established, employers must request and review their CDL drivers’ records from the clearinghouse annually. The MAP-21 Act also requires DOT to develop a method to electronically notify an employer of each additional positive test result or other noncompliance.

Summary

Drivers have a responsibility to be safe while behind the wheel.  Employers (motor carriers) have a responsibility to properly qualify and monitor the ongoing qualification status of those who drive for them.

Driver impairment, whether from drugs, alcohol, fatigue or medical conditions is foreseeable (through testing and qualification programs) and preventable so long as everyone does their part. 

To find out in hindsight that heavy vehicle crashes occurred where drivers were also receiving Social Security Administration disability benefits (and were not medically qualified to drive) is tragic if it were a mistake and a travesty if it occurred knowingly but was ignored.

SafetyFirst specializes in driver safety programs for both regulated and non-regulated fleets.  We have clients throughout the USA and Canada utilizing a wide range of proprietary database systems (for compliance with company or Federal policies affecting drivers, crash reporting, training documentation, qualification reminders, etc.), hotline coaching programs, and varied training/educational approaches.  We also consult with larger fleets and insurance carriers on developing strategies to assure effective implementation of telematics programs and other high capital projects where safety results depend on data analysis and translation to behavior safety outputs to realize and capture measurable gains.

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